Provider Demographics
NPI:1942608146
Name:TELANG, SHREYA RAVINDRA (OTR/L)
Entity type:Individual
Prefix:
First Name:SHREYA
Middle Name:RAVINDRA
Last Name:TELANG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 N MADISON AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1693
Mailing Address - Country:US
Mailing Address - Phone:626-675-0512
Mailing Address - Fax:
Practice Address - Street 1:290 N MADISON AVE APT 204
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1693
Practice Address - Country:US
Practice Address - Phone:626-675-0512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-21
Last Update Date:2014-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12637225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist